At an all-purpose health care facility, many specialized jobs must be staffed around the clock. Like other shift-work environments, substitute workers are often needed on very short notice, but where each job assignment requires a specialized skill, the available replacements are simply not interchange-able. Kaiser Permanente’s 24-hour medical facility in Stockton, CA now prescribes ScheduleSoft for lasting relief from this chronic scheduling headache.

Over 50 years ago, Kaiser’s founder set out to demonstrate that maintaining wellness is just as important as treating illness. Today Kaiser Permanente is the nation's largest nonprofit prepaid HMO. Its Health Plan and Hospitals are components of a Californian non-profit and charitable Corporation, with all net income committed to improving medical services, facilities and the communities Kaiser serves. Kaiser’s physicians, pharmacists, nurses and specialists work together to integrate medical services in their own hospitals, medical offices, pharmacies, and laboratories. And members need only to display their membership card for services; no other paper work is required.

With 1,000 miles of waterways for recreation, Stockton, CA (Population: 243,700) is located in the north-central part of California, 83 freeway miles east of San Francisco and 40 miles south of Sacramento. Kaiser's Stockton Medical Facility is mainly a "one-stop" outpatient clinic. Beneath a single roof, the clinic offers all the medical services that any Kaiser member is likely to need. But in addition to its outpatient clinic, the facility’s contract with Stockton’s Dameron Hospital provides overnight care and emergency services 24 hours per day, 7 days per week. All told, the Stockton Medical Facility employs 154 staff physicians and about 650 licensed and non-licensed staff.

Effective scheduling requires three types of data: information about job requirements, information about workers, and a set of rules for making scheduling decisions. In some small health care institutions, all of this information resides in the scheduler's head. Of course, having any system depend on one individual is a risky practice for even a small institution. In large institutions it can lead to disaster. Schedulers in larger round-the-clock health care environments have devised different systems to deal with the scheduling problem. Some work with spreadsheets, using one set of spreadsheets (or one very large spread sheet) to develop the schedule and others to gather and store information about the workers and their jobs.

To make such a system work, it can take months - or even years - just to build a database with all the needed information. A spreadsheet cannot learn and implement scheduling rules, so the scheduler must know the requirements and remember to apply them. But even after a scheduler who knows all the rules has built a good database, it takes a lot of work to generate a preliminary, long-term schedule on a spreadsheet. Some large businesses and institutions bring in software developers who design custom systems to meet their specifications. This costly solution is seldom as effective as the buyer expects it to be. Rarely do the designers know in advance exactly what to include in the software, so the debugging phase can go on for months (or again even years) with every new change eating more time and money.

Custom software installations are always time-consuming, risky, and very costly. At Kaiser Permanente's Stockton Medical Facility, Bill Bergstrom has found a far better solution. Several months ago he switched from paper-and-pencil scheduling to space-age “electronic calendars" by ScheduleSoft - an off-the-shelf program designed specifically for shift management. In ScheduleSoft, he found a very sophisticated scheduling program - developed far beyond the testing and development phase. That is a feature worth noting because Kaiser would still be looking ahead to the testing and development phase had Bergstrom signed on with a custom software developer. According to Bergstrom, ScheduleSoft was easy to learn and easy to use. The package included a tutorial, a step-by-step illustrated users guide, and on-line help. As Bergstrom described it, “You have success the very first time you use it.” ScheduleSoft is the most adaptable scheduling software on the market today without even considering price. After years of research, testing, and feature expansion, ScheduleSoft has incorporated enough built-in flexibility to work effectively in any shift-work environment.

Kaiser's transition to ScheduleSoft went so smoothly that it seemed like the program was custom-designed for the Stockton Medical Facility. ScheduleSoft quickly adapted to the Kaiser work environment and set out to learn the scheduling rules. To do that, the program prompted the scheduler for guidelines, and then automatically applied those guidelines in developing custom schedules. This led Bergstrom to comment, “I can now customize the schedule to meet the facility's needs, and that improves the services we provide to our customers.” To create its own the database, ScheduleSoft conducted an “interview” with the scheduler. After years of phoning customers for opinions and feedback, ScheduleSoft developers now know exactly the types of information needed to construct the perfect schedule. With this experience embodied in its code, the ScheduleSoft program takes the lead in gathering up the data it needs. It even prompts for details that not every scheduler would think to include. For example, ScheduleSoft requested information on the days and times when workers are available and when they are not available, the skills workers have for particular jobs, and the limitations and restrictions they bring to the job. ScheduleSoft also prompted for scheduling policies, including minimum shift requirements and the qualifications required for each "post."

By a mostly automated process, ScheduleSoft used this information to generate a preliminary schedule for the Stockton Medical Facility. It now can generate schedules by the day, week, month, or year, and it can schedule by department, group or employee. Staffing consultant Janie O'Connor quotes Shift Manager Kim Pandola in one of several papers she has written on how to develop good morale among shift workers (neither O’Conner or Pandola are from Kaiser). In this quote, Kim describes the importance of getting shift workers involved in the scheduling process so that they "hold themselves accountable to each other to make sure a team is intact to handle the job that needs to get done." Kim states that "management needs to determine the appropriate parameters, but the employees need to determine what works best for them."

This provides the highest level of flexibility, and it gives the workers more control over their own lives. If Kim Pandola is right, employees should have early access to a straw-man schedule so that they can participate in the scheduling process. With preliminary schedules furnished months, or even a year or more in advance, employees can see for themselves the needs for shift coverage. They can then decide among themselves the best arrangements to cover for vacations and other forms of leave. Bill Bergstrom generates a preliminary schedule 12 months in advance. This gives workers ample time to negotiate deals that serve the needs of Kaiser as well as themselves. And when a worker's plans are approved, ScheduleSoft can lock out a string of days so that no one can accidentally book that person for any conflicting assignments.

According to Bergstrom, “ScheduleSoft makes life a whole lot easier for long-range planning, vacations, educational leave, and other types of days off. The staff appreciates knowing who is where and when." The ScheduleSoft “electronic calendar” shows each shift and who is working. It displays both standard hours worked and non-duty assignments, such as vacation, sick leave, or training. Mr. Bergstrom noted how color codes and notes on the calendar make it easier for him to spot and correct any problems. Color highlighting makes it easy to map out shift assignments and spot the shifts that are either understaffed or over-staffed. To make information access simple and easy, ScheduleSoft creates a hot link for every name and shift it lists on the calendar.

A scheduler needs only to click on a name to open a tab-type listing of dialogs providing everything the scheduler might need to know about the worker and his or her assignments. The same is true for shift information. Just by clicking on a listed shift, an authorized scheduler can access the dialogs needed to view or change the rules and data related to that shift. The Stockton Medical Facility posts its official schedules from six weeks to a month in advance. Employees depend on this schedule to learn their current responsibilities. Of course, even with this schedule some last-minute changes cannot be avoided. As the need for changes arise in the schedule, ScheduleSoft highlights the problem so people will notice. It then assists in the selection of alternates based on rules established by the department.

All employees have viewing access to the work schedule, but only schedulers have the privileges needed to make changes. When an authorized person does change the schedule, ScheduleSoft can track each change so managers can learn the time and reason the change was made. ScheduleSoft tracks assignments by shifts, hours and user-defined accounting codes. It tabulates accrual rates and balances for vacation and sick time or anything else the department chooses to track. The Reports menu offers ten basic reports. The user selects the content to display in these reports by responding to prompt dialogs that appear when a report type is selected.

One of the two reports most frequently used at Kaiser is the Problem Day Report. It lists days in the schedule having unresolved worker assignments. Should a Medical Record clerk ask about his schedule, the Individual Report will display his shift assignments for any specified period, with any overtime conspicuously highlighted. And if Bill Bergstrom wants to know who is currently scheduled to work, the Active Shift Report shows all the workers on duty, and the start and end times of their shifts. Some reports can be useful as much to the Controller’s Office as they are to the scheduler. For example, the Monthly Department Report shows shift assignments by department. Bill Bergstrom often uses this report for schedule planning. When used after the fact, this same report provides Bergstrom with hours and shifts worked, listings by employee and time period.

Add to this the information available in the Accounting Code Report, which lists overtime by accounting codes, and Bergstrom has everything he needs to control his payroll budgets. Bill Bergstrom wants employees to take the initiative and share responsibility for the schedules that govern their time. This is a key reason why he welcomes the switch to ScheduleSoft at the Stockton Medical Facility. By generating schedules far in advance, ScheduleSoft gives workers the lead-time they need for effective self-management. He says that ScheduleSoft never limits his objectives or causes any problems.

He particularly likes the interview process, the way tours of duty are defined, the automated assignment of shift rotations, and the error-proof simplicity of ScheduleSoft's process for making needed changes. To sum up his views on ScheduleSoft's advantages, Bill had this to say: "Having the flexibility to respond quickly to customer needs through quick and accurate staff changes just makes good business sense.” ScheduleSoft® is a registered trademark